Partial radicular versus coronal pulpotomy using chitosan and platelet-rich fibrin in vital permanent molars with irreversible pulpitis, with or without associated apical periodontitis: A randomized controlled trial.

BACKGROUND: Recent developments in biologically oriented dentistry have encouraged preservation of pulpal tissue even in cases traditionally managed with root canal therapy (RCT). Evidence suggests that in many teeth diagnosed with irreversible pulpitis, the inflammatory process may not involve the entire pulp, allowing retention of viable radicular tissue through conservative procedures such as pulpotomy. Partial radicular pulpotomy is a conservative approach that requires further clinical validation. AIM: To comparatively evaluate the clinical and radiographic outcomes of coronal and partial radicular pulpotomy using chitosan and platelet-rich fibrin (PRF) in vital permanent molars presenting with symptomatic irreversible pulpitis, with or without apical periodontitis. SUBJECTS AND METHODS: Sixty-eight patients aged 15-35 years with cariously exposed mature permanent molars were randomly allocated into four groups: coronal pulpotomy with chitosan, coronal pulpotomy with PRF, partial radicular pulpotomy with chitosan, and partial radicular pulpotomy with PRF. All procedures were performed according to the standardized protocols, using Biodentine as the sealing material. A Visual Analog Scale was used to assess postoperative pain. Radiographic healing was evaluated using intraoral periapical radiographs and cone-beam computed tomography at subsequent follow-ups of 3, 6, and 12 months. STATISTICAL EVALUATION: To compare outcomes between groups, the Mann-Whitney U-test was applied, while survival outcomes were determined through Kaplan-Meier analysis. RESULTS: All groups showed a significant reduction in postoperative pain and radiographic healing. The overall 12-month survival rate was 88.2%, with the highest rate in the partial radicular pulpotomy with PRF group (94.1%), but there was no statistically significant difference (P > 0.05). CONCLUSIONS: Coronal and partial radicular pulpotomy demonstrated favorable outcomes. Partial radicular pulpotomy with chitosan or PRF may represent a reliable, minimally invasive alternative to conventional RCT.